Korean J Pain.  2014 Jan;27(1):30-34. 10.3344/kjp.2014.27.1.30.

Evaluation of Salivary Cortisol and Anxiety Levels in Myofascial Pain Dysfunction Syndrome

• Nadendla L
• Meduri V
• Paramkusam G
• Pachava KR

• KMID: 2278199
• DOI: http://doi.org/10.3344/kjp.2014.27.1.30

Abstract

BACKGROUND
Myofascial pain dysfunction syndrome (MPDS), otherwise called myofascial pain is one of the most common temporomandibular disorders, which in turn is the most common cause of orofacial pain of non-dental origin. Its etiology is multifactorial and still poorly understood. Psychological factors have been shown to play a role in the etiology. The aim of the study was to evaluate the association between anxiety and salivary cortisol levels in patients with myofascial pain.
METHODS
Twenty patients suffering from myofascial pain were recruited as the study group. The same number of age and sex matched healthy individuals were taken as the control group. The salivary samples collected between 9-9:15 am from both groups were analyzed for cortisol levels with the competitive enzyme-linked immunosorbent assay method. Anxiety levels of 40 patients were measured using Hamilton's anxiety scale.
RESULTS
The mean serum cortisol level of the MPDS group showed a highly significant difference (p < 0.001) from the controls. The mean anxiety scores of the MPDS group showed a highly significant difference (p < 0.001) from the controls. A positive correlation was found between anxiety and the salivary cortisol levels in MPDS patients.
CONCLUSIONS
These findings suggest that anxiety plays a vital role in the etio-pathogenesis of MPDS; thus, besides pharmacological treatment, psychological support is also needed.

Keyword

anxiety; ELISA; myofascial pain; salivary cortisol

MeSH Terms

Anxiety*
Enzyme-Linked Immunosorbent Assay
Facial Pain
Humans
Hydrocortisone*
Methods
Psychology
Temporomandibular Joint Disorders
Hydrocortisone

Reference

1. Rollman GB, Gillespie JM. The role of psychosocial factors in temporomandibular disorders. Curr Rev Pain. 2000; 4:71–81. PMID: 10998718.

2. Machado LP, Nery Cde G, Leles CR, Nery MB, Okeson JP. The prevalence of clinical diagnostic groups in patients with temporomandibular disorders. Cranio. 2009; 27:194–199. PMID: 19697648.

3. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992; 6:301–355. PMID: 1298767.

4. Chen CK, Nizar AJ. Myofascial pain syndrome in chronic back pain patients. Korean J Pain. 2011; 24:100–104. PMID: 21716607.

5. Reissmann DR, John MT, Wassell RW, Hinz A. Psychosocial profiles of diagnostic subgroups of temporomandibular disorder patients. Eur J Oral Sci. 2008; 116:237–244. PMID: 18471242.

6. Oral K, Bal Küçük B, Ebeoğlu B, Dinçer S. Etiology of temporomandibular disorder pain. Agri. 2009; 21:89–94. PMID: 19779999.

7. Jones DA, Rollman GB, Brooke RI. The cortisol response to psychological stress in temporomandibular dysfunction. Pain. 1997; 72:171–182. PMID: 9272801.

8. Yoshihara T, Shigeta K, Hasegawa H, Ishitani N, Masumoto Y, Yamasaki Y. Neuroendocrine responses to psychological stress in patients with myofascial pain. J Orofac Pain. 2005; 19:202–208. PMID: 16106713.

9. Koray M, Dülger O, Ak G, Horasanli S, Uçok A, Tanyeri H, et al. The evaluation of anxiety and salivary cortisol levels in patients with oral lichen planus. Oral Dis. 2003; 9:298–301. PMID: 14629330.

10. Safarzadeh E, Mostafavi F, Haghi Ashtiani MT. Determination of salivary cortisol in healthy children and adolescents. Acta Med Iran. 2005; 43:32–36.

11. Truelove E, Pan W, Look JO, Mancl LA, Ohrbach RK, Velly AM, et al. The research diagnostic criteria for temporomandibular disorders. III: validity of Axis I diagnoses. J Orofac Pain. 2010; 24:35–47. PMID: 20213030.

12. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959; 32:50–55. PMID: 13638508.

13. Manfredini D, Marini M, Pavan C, Pavan L, Guarda-Nardini L. Psychosocial profiles of painful TMD patients. J Oral Rehabil. 2009; 36:193–198. PMID: 19207446.

14. Kight M, Gatchel RJ, Wesley L. Temporomandibular disorders: evidence for significant overlap with psychopathology. Health Psychol. 1999; 18:177–182. PMID: 10194053.

15. Manfredini D, Bandettini di Poggio A, Cantini E, Dell'Osso L, Bosco M. Mood and anxiety psychopathology and temporomandibular disorder: a spectrum approach. J Oral Rehabil. 2004; 31:933–940. PMID: 15387831.

16. Uhac I, Kovac Z, Valentić-Peruzović M, Juretić M, Moro LJ, Grzić R. The influence of war stress on the prevalence of signs and symptoms of temporomandibular disorders. J Oral Rehabil. 2003; 30:211–217. PMID: 12535150.

17. Mercuri LG, Olson RE, Laskin DM. The specificity of response to experimental stress in patients with myofascial pain dysfunction syndrome. J Dent Res. 1979; 58:1866–1871. PMID: 290651.

18. Charney DS. Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am J Psychiatry. 2004; 161:195–216. PMID: 14754765.

19. Tortora GJ, Grabowski SR. Introduction to the human body: the essentials of anatomy and physiology. 5th ed. New York (NY): Wiley;2000.

20. Breedlove SM, Rosenzweig MR, Watson NV. Biological psychology: an introduction to behavioral, cognitive, and clinical neuroscience. 5th ed. Sunderland (MA): Sinauer Associates cop;2007.

21. Korszun A, Young EA, Singer K, Carlson NE, Brown MB, Crofford L. Basal circadian cortisol secretion in women with temporomandibular disorders. J Dent Res. 2002; 81:279–283. PMID: 12097314.

22. Nilsson AM, Dahlström L. Perceived symptoms of psychological distress and salivary cortisol levels in young women with muscular or disk-related temporomandibular disorders. Acta Odontol Scand. 2010; 68:284–288. PMID: 20500119.

23. Yap AU, Chua EK, Hoe JK. Clinical TMD, pain-related disability and psychological status of TMD patients. J Oral Rehabil. 2002; 29:374–380. PMID: 11966972.

24. Yap AU, Dworkin SF, Chua EK, List T, Tan KB, Tan HH. Prevalence of temporomandibular disorder subtypes, psychologic distress, and psychosocial dysfunction in Asian patients. J Orofac Pain. 2003; 17:21–28. PMID: 12756927.

25. Nifosì F, Violato E, Pavan C, Sifari L, Novello G, Guarda Nardini L, et al. Psychopathology and clinical features in an Italian sample of patients with myofascial and temporomandibular joint pain: preliminary data. Int J Psychiatry Med. 2007; 37:283–300. PMID: 18314857.